Care Home: Ferndale Home For The Elderly

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What the care home does well The home has an experienced manager with a clear leadership style that people, relatives and staff appreciate and have confidence in. There is good evidence to support that the home is well managed. The home is good at retaining staff and they are kept up to date with their training. The home exceeds the numbers of staff who should have a National Vocational Qualification. People living at the home are happy and comfortable in their surroundings. They are confident in the staff and manager, feel they can raise concerns and will be listened to. They think that the staff are friendly, caring and supportive and their relationships with them are good. Visitors feel welcome in the home, are free to come and go as they wish and feel they are kept informed of changes in people`s condition. People enjoy the food, it is wholesome, they get choice and are able to make suggestions. Relatives and people living at the home feel that there is a homely atmosphere and this is part of the reason they chose the home as a place to live. These are some of the positive comments made during the inspection either in writing or noted during conversations: `The care staff in this home always appear to be very caring, putting the needs of the residents first. Many of the staff have worked at the home for some time and know the residents and their colleagues very well, which helps to ensure that residents needs are better understood`. `Residents always appear to be treated as individuals`. `This is a very `homely` home which gives the impression of a `family home` where residents appear happy and relaxed`. `Friendly environment with staff who know the residents well. Plenty of stimulation/activities seem available and very respectful of needs`. `The home is very strong in respecting people`s privacy and dignity`. `I have lived at the home for almost 12 months and have no regrets at taking up residence at this home`. What has improved since the last inspection? The home has addressed issues raised in the previous inspection report. These were about recording of medication that is administered, fully completing job applications with two references and attending to some loose floorboards. The home has changed its Health and Safety Consultant and feel that the methodology is good helps keep up to date with current working practices and legislation. Staff training has been on going and further up dates and more specialist training is planned. The home is considering adding a ground floor bathroom and is currently looking at the feasibility and cost of this. What the care home could do better: The home continues to consistently maintain good standards of care. One requirement is made. Although the home was following the correct procedures for the storage and recording the administration of controlled drugs, this was on standardMedication Administration sheets so there were no problems in determining the drugs were being administered correctly. The record must however, be kept in a recognised Controlled Drugs Register and even before the inspection had been completed the owner was checking on the Internet where a register could be ordered from. The building has character, but also has its limitations and there is no bathroom on the ground floor. The owner is looking into the feasibility of adding a bathroom and this is encouraged to improve access for residents on the ground floor. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ferndale Home For The Elderly Britannia Road Morley Leeds LS27 0DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Newman     Date: 0 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ferndale Home For The Elderly Britannia Road Morley Leeds LS27 0DW 01132533196 01132380240 ferndale.rh@talktalk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ferndale Residential Home Limited Name of registered manager (if applicable) Mrs Betty Noble Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ferndale is a large detached property located in Morley, a suburb of Leeds, close to shops and other local facilities. It is registered to provide care, without nursing, for up to sixteen people over the age of 65. There are three floors but accommodation for people is on the ground and first floor. The lower ground floor houses an office, staff room, storage room and the laundry. Accommodation for people is in single and double rooms without en-suite facilities. A small number of bedrooms are available on the ground floor. A stair lift provides access to the first floor. However, people have to climb a flight of three stairs to the corridor where bedrooms, toilets and the home?s two bathrooms are located. This accommodation may therefore not be suitable for people with mobility problems. There are two comfortable lounges and a dining room on the ground floor. Care Homes for Older People Page 4 of 27 0 Over 65 16 care home 16 Brief description of the care home The gardens are well maintained with outdoor seating areas for people. There is a ramp leading to the front entrance. The home is on a main bus route from the city centre and there is a car park to the rear of the building. The current fees range from 421 pounds to 436 pounds per week with additional charges for hairdressing and chiropody. Newspapers and toiletries are included in the fees charged. The manager provided this information to the Commission for Social Care Inspection on 3 February 2009. Further information is available in the homes statement of purpose and service user guide that are available at the home. Copies of previous inspection reports are available in the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that the people who use the service experience good quality outcomes. The accumulated evidence in this report has included, the previous key inspection, information we have received from the provider since the last inspection, what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement, relevant information from other organisations and information from people living at the home, relatives, staff and other health care professionals. Care Homes for Older People Page 6 of 27 One inspector made an unannounced visit to the home that lasted six hours on 3 February 2009. Before the inspection visit, we asked the manager to complete an Annual Quality Assurance Assessment (AQAA). This is a self assessment that if completed thoroughly, should tell us how the home is meeting National Minimum Standards, where we can find the evidence for this, what improvements have been made since we last inspected and what improvements are planned in the next year. The AQAA that was returned was completed well and provided good detail. This was used to plan the inspection visit. During the visit a number of pre selected documents were looked at and most areas of the home used by people living there were inspected, including some bedrooms. Apart from spending time with the owner and manager, a good proportion of time was spent speaking with staff, visitors and people living in the home. Time was spent in communal areas watching what was going on and checking how the staff cared for and supported people. Surveys were sent out prior to the inspection to a proportion of people living at the home, staff and health care professionals. Feedback was provided to the owner and manager and this included an analysis of the survey results. What the care home does well: What has improved since the last inspection? What they could do better: The home continues to consistently maintain good standards of care. One requirement is made. Although the home was following the correct procedures for the storage and recording the administration of controlled drugs, this was on standard Care Homes for Older People Page 8 of 27 Medication Administration sheets so there were no problems in determining the drugs were being administered correctly. The record must however, be kept in a recognised Controlled Drugs Register and even before the inspection had been completed the owner was checking on the Internet where a register could be ordered from. The building has character, but also has its limitations and there is no bathroom on the ground floor. The owner is looking into the feasibility of adding a bathroom and this is encouraged to improve access for residents on the ground floor. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can decide to live at the home based on up to date and accurate written information that is available and visits to the home so they have a clear picture of the services and facilities provided. People are properly assessed before admission so all concerned can be sure the home can meet their needs. Evidence: The home has a service user guide and statement of purpose that are offered to people considering living at the home. These accurately reflect the services and facilities provided at the home and there are plans to update and improve the presentation of the documents. People spoken with said that they had looked at other homes before choosing Ferndale. They felt they had been warmly welcomed at the home, been given good information and felt there was a nice homely atmosphere and Care Homes for Older People Page 11 of 27 Evidence: this was the primary reason for making the choice to live there. Surveys that were returned showed that people had been given enough information before making their decision. Three care plans were checked to make sure that a pre admission assessment had been carried out. The essential care needs had been identified and used as the basis of the plan of care. Easy care documentation was also available. Since the last inspection more staff have been trained in carrying out pre admission assessments and are more aware of the information needed to assess that the home would be able to meet a persons needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the care they need and the care plans provide sufficient information and guidance to staff on how to meet peoples needs. People get the support and treatment of specialist health care professionals when they need it. People are treated with respect and live in a dignified way. Evidence: The three care plans that were checked showed that information from the pre admission assessment had been accurately used to complete a care plan. The home uses a scandex system of documentation for its care plan recording that staff are experienced in using. The plans seen addressed individual health, personal and social care needs and are supported by a range of risk assessments. The written guidance for staff to follow was clear. Nutritional screening is done and there was evidence of monthly weight checks or more often if necessary. The plans outline peoples preferred Care Homes for Older People Page 13 of 27 Evidence: daily routines and lifestyle choices. Staff spoken with knew the people the cared for well and know the personal lifestyle preferences and choices that make each persons quality of life and living experience at the home as good as possible. There was evidence in the care plans of contact with health care professionals and the recording of visits made by the Doctor was good in its detail so that staff were very clear of the Doctors diagnosis, advice and treatment. Two surveys were returned from health care professionals who visit the home on a regular basis. These were positive and some of the written comments made were: The care staff in this home always appear to be very caring, putting the needs of the residents first. Many of the staff have worked at the home for some time and know the residents and their colleagues very well, which helps to ensure that residents needs are better understood. Residents always appear to be treated as individuals. This is a very homely home which gives the impression of a family home where residents appear happy and relaxed. Friendly environment with staff who know the residents well. Plenty of stimulation/activities seem available and very respectful of needs. The home is very strong in respecting peoples privacy and dignity. The home has a policy on the safe handling, storage, disposal and administration of medication. These were discussed with staff on duty and observations and checks made including controlled drugs. These were sound although the home must record the administration of drugs in a recognised controlled drugs register. The surveys, conversations during the day and observations made, showed peoples dignity and privacy is promoted. People looked well cared for, staff were seen knocking on doors and making sure that doors were closed at times when personal care was being given. People spoken with said that staff look after them well and sensitively when assisting them with bathing, washing and dressing. Indeed the professional and warm way that staff related to people, including visitors, was one of the most positive features of the day. The views expressed in surveys returned by people living at the home were positive and one written comment said: I have lived at the home for almost 12 months and have no regrets at taking up residence at this home. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to keep in touch with family and friends and lead their chosen lifestyle as far as they are able. People have the opportunity to join in a range of social activities. People have nutritious meals and snacks that offer them choice so that they can eat healthily with support, assistance and encouragement if they need it. Evidence: The home has a range of activities for people to join in. These include in-house things like games, puzzles, quizzes and reminiscence sessions. There is a good selection of books available together with newspapers and magazines and staff sometimes read pout topics or articles to prompt discussion. Exercise sessions are held weekly by an external specialist. Entertainers visit including a pianist, accordion player and local theatre group concerts and church choirs. There are outings to shopping centres, garden centres, the theatre and coffee mornings. Residents who wish are taken to their church for worship and other activities. One resident said that people from her own church come and collect her. Local clergy visit the home on a regular basis. Care Homes for Older People Page 15 of 27 Evidence: The hairdresser was making her weekly visit. She said she felt that the staff were very caring and looked after the people well. Although no visitors were spoken with, there having been heavy snow overnight and difficulties with travel, people gave the clear indication that they have regular visitors and the home considers that because it is size, relationships develop with families and the family home idea is promoted with visitors welcome at all times. In their conversations, people said that they sort out their own routines, like getting up, bed times and what they do with their time. One person enjoys walks out each day and was a a bit fed up that the snow was preventing her. Several ladies had their hair done during the day and people were Happy with the arrangements for their optical, dental and foot care. Peoples likes, dislikes and dietary needs are recorded and all agreed that the food was good, there was plenty of it and they were offered choice. The menus seen were varied and nutritious. The main meal of the day was a social occasion, was not hurried and any support needed was given sensitively. Regular drinks and refreshments were offered throughout the day and there was fresh fruit available. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns about their care, they or people close to them know how to complain and feel comfortable in doing so. Their concerns are looked into and actions taken to put things right. The care home safeguards people from abuse and neglect and takes actions to follow up allegations. Evidence: The home has a formal complaints procedure that is displayed in the reception area and is included in the service user guide. People said that they felt comfortable in raising issues and they or their relatives are encouraged to raise matters straight away so that things can be sorted out quickly, but where the formal complaints procedure might be used, records would be kept to show what the problem was, what actions were taken and how things were resolved. Staff spoken with and the training records seen showed that training is provided in recognising abuse and actions that must be taken if abuse is suspected. There are policies and procedures to support this including whistle-blowing. Other checks made during the inspection visit on recruitment, medication and money held for safekeeping all met requirements. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained home that is clean, pleasant and hygienic and considered homely. Evidence: A tour of the premises was made and things were found to be clean, well maintained and to the credit of the housekeeping staff, free from unpleasant odours. Bedrooms were comfortable and personalised and there is a programme of redecoration and refurbishment. The building has operated as a care home for many years but would not meet current registration standards. It does however, have character and has a homeliness that people appreciate. The owner is looking into the possibility of adding a downstairs bathroom added and plans are currently being drawn up and costed for consideration. Specialist equipment is provided where necessary for individuals and to meet requirements to move and handle people safely or reduce the risk of pressure sores. Training is provided in its use. The emergency call system was checked and a speedy response made and the people spoken with said that this was normal. Records of safety checks on equipment were Care Homes for Older People Page 19 of 27 Evidence: available and those checked were up to date. The surveys and conversations with people suggest that they consider the home to have a homely atmosphere and always clean and tidy. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and good support from staff who are competent and well trained. Staff go through a thorough recruitment process that includes checks to make sure they are suitable to care for them. Peoples care needs are met by staff whose training is kept up to date and are well supported and supervised by the manager. Evidence: The surveys that were returned and the conversations during the day give a clear indication that people, relatives and professional visitors think there are enough staff on duty and that they are well trained and competent. The home is good at retaining staff and the conversations with staff showed that they had a good team spirit and like working with each other. Staff described the home as being one big family. Good practice was seen in the support to people with dementia and staff have received training in the care of people with dementia. The personnel files for two staff were checked to make sure the home carries out good recruitment procedures. All staff had application forms, job descriptions, induction checklists, a contract of employment, two references (one being from the last employer) and the necessary checks with the Criminal Records Bureau had been made. This makes sure that people are protected from staff who may not be suitable to work in the care industry. Care Homes for Older People Page 21 of 27 Evidence: There is a training programme and the records seen and conversations with staff showed that they are up to date with safe working practice training that includes fire safety, food hygiene, moving and handling, infection control, the protection of vulnerable adults and for those staff involved in medication, the safe handling of medication. There are plans this year to provide further training in dementia and palliative care. The home exceeds targets for the numbers of care staff who should gain a National Vocational Qualification (NVQ). From what was seen during the visit, people look well cared for, have warm relationships with staff and there is a relaxed friendly atmosphere in the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the right support because there is effective and supportive management. There is an open approach to staff, people and visitors that makes them feel valued and respected. People are safeguarded because the home has clear financial and accounting procedures, keeps records properly and makes sure that staff understand policies and procedures and follow the way things should be done. Safety checks on facilities and equipment make sure the home is a safe place to live and work. Evidence: The manager is very experienced in the care industry and has over 15 years experience in the management role and holds a relevant management qualification. There was evidence in the surveys and from conversations during the visit that people Care Homes for Older People Page 23 of 27 Evidence: think she is approachable and supportive. The home carries out its own satisfaction survey and actions are taken to make some of the improvements suggested. There are regular resident meetings where they can express their views about home life and similarly regular staff meetings and individual supervision sessions for them to discuss work, any problems and their individual training needs. Some peoples personal money is held for safe keeping. The systems for keeping and recording were discussed to make sure that money is safe and properly accounted for. One persons records were checked and receipts for all purchases were held to support the transactions. Based on this, people can be assured their money is well looked after and accounted for. Staff were seen to be wearing protective clothing to reduce the risk of cross infection and their training is up to date. The AQAA confirmed that regular safety checks are made of facilities and equipment to make sure the home is a safe place to live and work. Staff are trained in safe working practices and are up dated on a regular basis. Some checks were made of records of safety checks, like fire safety, and were found to be up to date. Accident records were also seen and these are audited by the manager to see if measures can be taken to reduce the risk of accidents. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The administration of controlled drugs must be recorded in a recognised controlled drugs register. This will ensure that the home fully follows NMC guidelines. 20/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 The home should continue to investigate the feasibility of adding a bathroom on the ground floor. This will improve accessibility for all people living at the home. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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